[Diagnostic problems and prognostic factors in prostate cancer]

Area of Science:

• Uropathology
• Oncology
• Surgical Pathology

Background:

• Accurate preoperative differentiation between ductal adenocarcinoma (DAP) and acinar adenocarcinoma (AAP) of the prostate is crucial for treatment planning.
• Ductal prostate carcinoma is suspected to be a more aggressive subtype, necessitating precise diagnostic methods.
• Predicting extracapsular extension (ECE) preoperatively aids in surgical decision-making for radical prostatectomy (RP).

Purpose of the Study:

• To refine methods for accurately discriminating between DAP and AAP preoperatively.
• To confirm if DAP is a more aggressive prostate cancer subtype.
• To evaluate the clinical utility of transrectal ultrasound-guided biopsies in predicting ECE at RP.

Main Methods:

• Retrospective analysis of 110 radical prostatectomy (RP) cases with 3D histology and biomarker analysis.
• Analysis of 84 cases undergoing transrectal ultrasound-guided systematic sextant or octant biopsies.
• Correlation of positive biopsy counts with ECE, PSA, and Gleason score; chi-square analysis and predictive value calculations.

Main Results:

• DAP cases showed significantly higher rates of advanced cancer, positive surgical margins, ECE, vascular invasion, and metastases compared to AAP.
• A combination of three biomarkers (chromogranin A, EGFR, p53) distinguished DAP from AAP with 94% accuracy.
• The number of positive biopsies correlated significantly with ECE; predictive models combining biopsy results, PSA, and Gleason score accurately stratified ECE risk.

Conclusions:

• Both 3D histology and a panel of three biomarkers can accurately differentiate DAP from AAP, guiding treatment strategies.
• DAP requires more aggressive treatment regimens, while AAP may benefit from less radical approaches.
• The number of positive biopsies, alone or with other parameters, reliably predicts the probability of ECE at radical prostatectomy.